Hypertension Presentation

Introduction

• Hypertension or high blood pressure is a chronic condition with elevated blood pressure in the arteries.
• Major risk factor for:
  • Coronary artery disease
  • Stroke
  • Heart failure
  • Renal disease
  • Peripheral vascular disease
• Blood pressure noted by two measurements: systolic and diastolic pressure.

Blood Pressure Measurements

• High blood pressure:
  • Diastolic > 90 mmHg
  • Systolic > 140 mmHg
• Pre-hypertensive values:
  • Diastolic: 80 - 99 mmHg
  • Systolic: 120 - 139 mmHg
• Known as a "silent killer": asymptomatic for years until complications.

Factors Regulating Blood Pressure

• Blood pressure = cardiac output x total peripheral resistance
• Four active roles: heart rate, blood vessel tone, kidney, hormones.
• Baroreceptor reflex: important mechanism to maintain blood pressure.

Types of Hypertension

Primary Hypertension

• 90-95% of cases; no obvious cause.
• Linked to obesity, insulin resistance, diabetes.
• Typically increases with age.

Secondary Hypertension

• Attributable to identifiable conditions affecting kidneys, arteries, heart, endocrine system.
• Correctable conditions.

Causes of Secondary Hypertension

• Medications: oral contraceptives, estrogens, etc.
• Kidney diseases: renal parenchymal disease, renal artery stenosis.
• Hormonal system: renin-angiotensin-aldosterone system (RAAS).
• Mechanical: coarctation of the aorta.
• Endocrine causes: pheochromocytoma, Cushing's syndrome, thyroid abnormalities.

Complications and Organ Damage

• Target organ damage due to hypertension affects:
  • Heart: ischemic heart disease, heart failure.
  • Brain: stroke, cognitive impairment, dementia.
  • Kidneys: chronic kidney disease.
  • Eyes: hypertensive retinopathy.
• Hypertensive crisis: acute organ impairment due to severe BP elevation.

Management of Hypertension

Lifestyle Modifications

• Diet high in fruits and vegetables, low-fat dairy, reduce salt and potassium.
• Decrease alcohol, maintain healthy weight, regular exercise.
• Quit smoking, stress management.

Medications

• If lifestyle changes ineffective, medications prescribed.
• Four classes:
  • Diuretics: decrease circulating volume.
  • Sympatholytics: beta blockers, alpha antagonists.
  • Vasodilators: calcium channel blockers.
  • ACE inhibitors and ARBs: interfere with RAAS.
• Beta blockers vs ACE inhibitors: ACE preferred for diabetes/kidney protection.

Conclusion

• Hypertension management includes lifestyle changes and medications.
• Monitoring and early intervention key to prevent complications.